DR. JULIUS PARK (NPI# 1710022942) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710022942 |
| Entity Type | Individual |
| Full Name | DR. JULIUS PARK |
| Credential | D.M.D. |
| Practice Address |
1816 Eagle Dr 200-c Woodstock GA 30189-8272 |
| Practice Telephone | 7709269260 |
| Practice Fax Number | 7709269263 |
| Mailing Telephone | 7709269260 |
| Mailing Fax Number | 7709269263 |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2010-09-22 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
DN013851 | GA | Dental Providers |
| N | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
050223 | NY | Dental Providers |
| N | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
22DI02198100 | NJ | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 02731033 | 05 |
| Street Address |
1816 EAGLE DR 200-C |
| City | WOODSTOCK |
| State | GA |
| Zip Code | 30189-8272 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013997139 | Ross Joseph Brakeville | Physical Therapist | 1816 Eagle Dr, Building 100, Suite C, Woodstock, GA 30189-8272 | 2006-01-17 |
| 1306203427 | Kragor Orthodontics LLC | Dentist | 1816 Eagle Dr, Suite 100-b, Woodstock, GA 30189-8272 | 2016-01-20 |
| 1336420017 | Robert Riesing | Physical Therapist | 1816 Eagle Dr, Suite C, Woodstock, GA 30189-8272 | 2011-09-08 |
| 1346540432 | Park Pediatric Dentistry of Woodstock, LLC | Dentist | 1816 Eagle Dr, Suite 200-c, Woodstock, GA 30189-8272 | 2010-10-24 |
| 1750514295 | Eagle Drive Family Medicine PC | General Practice | 1816 Eagle Dr, Suite 200-b, Woodstock, GA 30189-8272 | 2009-09-01 |
| 1972659332 | Pt Solutions of Acworth, LLC | Physical Therapist | 1816 Eagle Dr, Building 100, Suite C, Woodstock, GA 30189-8272 | 2007-01-26 |
| 1538210695 | Scott Harden | Dentist | 1816 Eagle Dr, Bldg 200 Ste A, Woodstock, GA 30189-8272 | 2007-01-16 |
| 1548299332 | Richard Leon Manrique | Emergency Medicine | 1816 Eagle Dr, Suite 200-b, Woodstock, GA 30189-8272 | 2006-07-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801494356 | Susan Iruku | Pharmacist | 12050 Ga-92 #112, Woodstock, GA 30189 | 2020-10-15 |
| 1598267437 | Kelly Sierra | Nurse Practitioner | 100 Stoneforest Dr Ste 300, Woodstock, GA 30189 | 2018-03-07 |
| 1548770449 | Chandra Johnson | Nurse Practitioner | 295 Molly Lane Ste 150, Woodstock, GA 30189 | 2017-10-05 |
| 1083133912 | Amanda Bostock Sowisdral | Physician Assistant | 250 Parkbrooke Pl Ste 300, Woodstock, GA 30189 | 2017-09-12 |
| 1780101659 | Laura C Koch Woodstock LLC Dba Fountain View Dentistry | Dentist | 1816 Eagle Drive, Building 200-a, Woodstock, GA 30189 | 2017-08-23 |
| 1265954788 | Vicky Morton Bryan | Nurse Practitioner | 422 Sycamore Trail, Woodstock, GA 30189 | 2017-07-17 |
| 1063933588 | Marietta Eye Clinic, Pa | Optometrist | 2990 Eagle Dr Ste 110, Woodstock, GA 30189 | 2017-07-06 |
| 1275914749 | Nrup Tolat | Podiatrist | 100 Stoneforest Dr Ste 120, Woodstock, GA 30189 | 2015-06-10 |
| 1558781534 | Mary Jansson Carmon | Nurse Practitioner | 1000 Towne Lake Pkwy, Woodstock, GA 30189 | 2014-04-17 |
| 1518388941 | Afc Physicians of Georgia, PC | General Practice | 6440 Bells Ferry Rd, Woodstock, GA 30189 | 2014-01-03 |
| Find all providers in zip 30189 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336296029 | Shiva Hejazi-werner | Dentist | 250 Parkbrooke Pl, Suite 250, Woodstock, GA 30189-6400 | 2007-01-04 |
| 1255439840 | Carlos A Garza Gongora | Dentist | 2320 Towne Lake Parkway, Building 1300 Ste 100, Woodstock, GA 30189 | 2006-09-20 |
| 1194746610 | Claudia E. Tomaselli, D.m.d., P.C. | Dentist | 375 Parkway 575, Suite 100, Woodstock, GA 30188-6439 | 2006-07-21 |
| 1316207996 | Travis Kimathi Dds PC | Dentist | 375 Parkway 575, #100, Woodstock, GA 30188-6439 | 2012-05-17 |
| 1295015709 | Kunjan Patel | Dentist | 2230 Towne Lake Pkwy, Bldg 1300 Suite 100, Woodstock, GA 30189-5540 | 2011-08-29 |
| 1346540432 | Park Pediatric Dentistry of Woodstock, LLC | Dentist | 1816 Eagle Dr, Suite 200-c, Woodstock, GA 30189-8272 | 2010-10-24 |
| 1932375128 | Menka Malhotra | Dentist | 2230 Towne Lake Parkway, Building 1300, Ste 100, Woodstock, GA 30189-5524 | 2008-05-07 |
| 1679697064 | Charles Oakley Coulter | Dentist | 2230 Towne Lake Parkway, Building 1300 Suite 100, Woodstock, GA 30189 | 2007-03-19 |
| 1649335746 | Todd Asarch | Dentist | 2230 Towne Lake Pkwy, Bldg 1300 Ste 100, Woodstock, GA 30189 | 2006-12-27 |
| 1902965932 | Childrens Dentistry of Woodstock | Dentist | 2230 Towne Lake Pkwy, Bldg 1300 Ste 100, Woodstock, GA 30189 | 2006-12-06 |
| Find all providers in WOODSTOCK | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.